Transcript Health Literacy

In It Together:
National Health
Literacy Project
for Black MSM
This project is/was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U69HA30143:
Building Ryan White HIV/AIDS Program Recipient Capacity to Engage People Living with HIV in Health Care Access. This information or content and conclusions are those of the author and
should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.
The persons shown in photographs on this website/tool/resource are models and are being used for illustrative purposes only.
Training goal
Participants will understand how limited health literacy
affects the health of their clients.
Participants will also understand how to apply health literate
approaches and techniques to help their HIV clients obtain,
process, and understand health information and services.
2
Training objectives
By the end of this training, you will be able to:
 Explain what health literacy means
 Recognize indications that your clients are experiencing
limited health literacy
 Apply health literate approaches to improve communication
with your clients
 Understand why a health literate organization is important
to Black MSM
 Understand what steps you and your organization can take
to promote health literacy and deliver health literate HIV
services
3
Definition of health literacy
Health Literacy: the degree to which an individual has the
capacity to obtain, communicate, process, and understand
basic health information and services to make appropriate
health decisions.
People need health literacy skills to:
 Read prescription bottles
 Read appointment slips
 Listen to and follow directions
 Interact with health care professionals
Source: Patient Protection and Affordable Care Act of 2010, Title V
4
Who does limited health literacy affect?
89 million adults, or
36% of the U.S.
adult population
have limited health
literacy
American Medical Association. (2013). http://www.ama-assn.org/ama/pub/about-ama.page
5
Who does limited health literacy affect?
All populations can be affected by limited health
literacy
Populations most affected by limited health literacy
include:
 Elderly adults
 People of low socioeconomic status
 People who are unemployed
 People who did not finish high school
 Members of minority groups
 People who did not speak English during early childhood
6
How does limited health literacy affect
people?
People with limited health
literacy skills:
 Report poorer overall health
 Have poorer ability to manage
chronic diseases
 Have poorer health outcomes
 Are less likely to understand their
diagnosis
 Are less likely to have screening/
preventive care
 Often seek care in later stages of
disease
American Medical Association. (2013). http://www.amaassn.org/ama/pub/about-ama.page
7
8
Possible signs that a client is
experiencing limited health literacy
A client may be experiencing
limited health literacy if he:
 Does not take his medications
correctly
 Frequently misses his appointments
 Fails to follow through on his tests or
referrals
 Does not complete his intake forms
 Is unable to provide a detailed history
of his illness or treatments
 Asks few questions
 Does not remember information read
earlier
9
Signs of limited health literacy specific
to people living with HIV/AIDS
A client may be experiencing limited health
literacy if he:
 Has a consistently high or unchanged viral load
 Does not take antiretroviral therapies correctly
 Is hospitalized frequently
 Falls out of care
 Skips important preventive measures
 Cannot explain HIV or AIDS
10
11
Black MSM experiences: homonegativity
Homonegativity: acceptance of societal anti-gay
attitudes toward oneself, leading to:
 Internalized conflict
 Devaluation of oneself
 Lack of concern for health and well-being
 Negative feelings about own sexuality
 Stress
 Shame of HIV status
Mayfield, W. (2001). The development of an internalized homonegativity inventory for gay men.
Journal of Homosexuality, 41(2), 53-76.
Meyer, I. H. & Dean, L. (1998). Internalized homophobia, intimacy, and sexual behavior among
gay and bisexual men. Stigma and sexual orientation: Understanding prejudice against
lesbians, gay men, and bisexuals, 4, 160-186.
12
Black MSM experiences: stigma
 Stigma: an attribute that is deeply discrediting
 Stigmatizing social environments negatively affect
health-related outcomes
 Sexual stigma: negative regard, inferior status, and
relative powerlessness that society accords to any nonheterosexual behavior, identity, relationship, or
community
Goffman, E. (1963). Stigma: Notes on the Management of Spoiled Identity. Prentice-Hall, Englewood
Cliffs, NJ.
Christensen, J. L., Milller, L. C., Appleby, P. R., Corsbie-Massay, C., Godoy, C. G., Marsella, S. C.,
and Read, S. J. (2013). Reducing shame in a game that predicts HIV risk reduction for young adult
MSM: A randomized trial delivered nationally over the web. Journal of the International AIDS
Society, 16,(Suppl 2) 18716
13
Black MSM responses to stigma include:
 Guilt
 Withdrawal
 Fear
 Self-harm
 Loss of self-worth
 Denial
 Shame
 Isolation
 Deceit
 Defensiveness
 Depression
14
Where Black MSM experience stigma
 Work environments and
business establishments
 Family gatherings
 Friend groups and social
settings
 Institutions of faith
 Institutions of learning
 Health care facilities
15
16
Specific cultural factors that may
influence the health literacy of Black
MSM
 Country of origin
 Medical mistrust
 Region
17
Socioeconomic factors that impact
Black MSM health literacy






18
Educational level
Emotional state
Housing status
Incarceration
Poverty
Situational context
19
Why HIV care/treatment instructions are
difficult
 Constant stream of new science and information
 Explanations use complicated medical terms
 Information is complex
20
21
Strategies to improve patient
perceptions of health professionals
 Be self-aware
 Acknowledge your limitations
 Sit down with patient
 Slow down your speech
 Portray approachable body
language
 Make patient feel valued
22
Strategies to improve spoken
communication
 Use plain, non-medical language
 Limit content to 2-3 main points
 Repeat key points multiple times
 Incorporate words/expressions used by client
 Give instructions specific and appropriate to client’s life
 Encourage client to ask questions
23
24
The Ask Me 3™ approach
1. What is my main problem?
2. What do I need to do?
3. Why is it important for me to do this?
I may not
vocalize my
questions.
25
How to use Ask Me 3™ in your client
encounters
Use the 3 questions to frame
your conversations with
your clients:
 What is the problem we
need to address today?
 What do I want to make
sure you understand (what
do I want you to do)?
 Why is it important that you
do this?
26
The Teach Back method
 Easily recalled 3-step process:
 Explain
 Check
 Re-explain if needed
 Helps health professionals gauge
how well the information was
taught and what needs to be
clarified or reviewed
 Is effective regardless of patients’
health literacy abilities
 Shown to improve outcomes for
patients with all literacy levels
27
Tips for using Teach Back method
 Start the conversation with:
 I want to make sure that I did a good job
explaining everything to you. Help me check
by describing…
 We covered a lot of information today and I
may have gone through the information too
quickly - help me see if I left anything out…
 Encourage the client to teach you by saying:
 In your own words, tell me…
 How will you explain…
 What will you do if…
 When will you…
28
The Show Me approach
 Can be used to
confirm
understanding of a
skill or action by
‘showing’ the skill or
action
29
30
Practice scenarios
Ray is a 33 year-old restaurant manager who
was recently diagnosed as HIV positive.
Homophobia is very common in his
community and though his close friends and
boyfriend know his HIV status, the vast
majority of his family and friends do not. Ray
is extremely nervous to start his ART
treatment program because he’s afraid that
people will find out that he’s homosexual and
HIV-positive.
What would you say to him about starting
ART?
Ricky is a 20 year old college student who is
still dating his boyfriend from high school,
even though he goes to a different school.
Because they were so young when they
started dating, Ricky has never slept with
anyone outside of the relationship and
believes his boyfriend has done the same. As
part of a routine physical from his doctor,
Ricky is shocked to find out that he is HIVpositive when he sees his doctor for a routine
physical.
How would you talk to him about his
diagnosis?
Oliver is 63 years old. Oliver and his husband have been happy together for the past 30 years.
In his free time, Oliver likes to play basketball and watch “Scandal”. As he starts to prepare for
retirement, Oliver came down with flu-like symptoms and went to see his doctor to get
checked out. After agreeing to a full patient exam, Oliver is diagnosed HIV-positive.
How would you talk to him about his diagnosis?
31
32
Tips for creating great health literate
patient material
Consider how the material will be used
Make it immediately appealing
Create a clear and obvious path for the eye to
follow
Maintain a consistent style and structure
Select font that is 12 point or larger
Use fonts that are easy to read (Times New
Roman, Arial, Calibri) Department of Health and Human Services, Indian Health Service
(n.d.). Checklist for creating patient education materials. Accessed
at https://www.ihs.gov/healthcommunications/
33
Tips for creating great health literate
patient material
Try to use:
Avoid:
 Simple words with few
 ALL CAPITAL LETTERS
syllables
 Short sentences: 10 to 15
words
 Words or phrases familiar
to the audience
 Active voice
 Italicized or underlined text
34
 Acronyms and contractions
 Technical words or jargon
35
Components of eHealth Literacy
Traditional Literacy
Health Literacy
Computer Literacy
Media Literacy
Information Literacy
Scientific Literacy
36
General tips for using social media to
engage your audience
 Find and engage influencers
 Cross-post: create content once
and reuse it often.
 Let your audience determine the
best technology to reach them;
don’t let trends in technology drive
your platforms
 Embrace user-centered design
 Measure progress towards your
objectives
 Be mindful of concerns about
privacy on public pages
37
38
The universal precautions approach
All clients benefit from
easy-to-understand
materials and simple
spoken communication.
Medical care is
complicated, and many
people struggle with
understanding medications,
self-care, instructions, and
follow-up plans.
39
40
Brach, C., Dreyer, B., Schyve, P., Hernandez, L., Baur, C., Lemerise, A., and Parker, R. (January
2012). Attributes of a Health Literate Organization. Institute of Medicine Roundtable on Health
Literacy.
10 attributes of health literate
organizations
1. Has leadership that makes health
literacy integral to its mission,
structure, and operations
2. Integrates health literacy into
planning, evaluation measures,
patient safety, and quality
improvement
3. Prepares the workforce to be health
literate and monitors progress
4. Includes populations served in the
design, implementation, and
evaluation of health information and
services
5. Meets the needs of populations
with a range of health literacy skills
while avoiding stigmatization
6. Uses health literacy in interpersonal
communications and confirms
understanding at all points of
41
contact
7. Provides easy access to health
information, services, and
navigation assistance
8. Designs and distributes print,
audiovisual, and social media
content that is easy to understand
and act on
9. Addresses health literacy in highrisk situations, including care
transitions and communications
about medicines
10. Communicates clearly what health
plans cover and what individuals
will have to pay for services
10 attributes of health literate
organizations
Attribute 1: Have leadership that makes
health literacy integral to its mission,
structure, and operations
Attribute 2: Make health literacy a part of
planning, evaluation measures, patient
safety, and quality improvement
Attribute 3: Prepare the workforce to
be health literate and monitors progress
42
10 attributes of health literate
organizations
Attribute 4: Include populations served in the
design, implementation, and evaluation of health
information and services
Attribute 5: Meet needs of populations with
different levels of health literacy skills to avoid
stigma
Attribute 6: Use health literacy strategies in
communications and confirms understanding at
all points of contact
43
10 attributes of health literate
organizations
Attribute 7: Provide easy access to health information,
services. and navigation assistance
Attribute 8: Design and distribute print, audiovisual, and
social media content that is easy-to-understand and
actionable
Attribute 9: Address health literacy in high-risk situations,
including care transitions and communications about
medicines
Attribute 10: Communicate clearly what health insurance
plans cover and how much individuals will have to pay for
services
44
45
Why are health literate organizations
important to Black MSM?
46
Why are health literate organizations
important to Black MSM?
 Almost half of gay and bisexual men say that they’ve never discussed
their sexual orientation with their doctor
 3 in 10 gay and bisexual men say that they don’t feel comfortable
discussing sexual behaviors with health professionals
 3 in 10 gay and bisexual men don’t have a regular physician
 6 in 10 gay or bisexual men say they rarely or never discuss HIV when
they visit their doctor
 Almost 2 in 10 gay and bisexual men say that they experienced poor
treatment from a medical professional, and 1 out of 4 experienced poor
treatment in the last year
 Almost 8 in 10 gay and bisexual men feel that the general public is
unaccepting of people living with HIV
 More than half of gay and bisexual men say that HIV-related stigma
makes it difficult to reduce the spread of HIV
Hame, L., Firth, J., Hoff, T., Kates, J., Levine, S., Dawson, L. (2014). HIV/AIDS In The Lives of
Gay and Bisexual Men in the United States. The Henry J. Kaiser Family Foundation.
47
Suggestions for starting a discussion of
health literacy in the workplace
 Include information on health literacy during staff
orientation
 Present on health literacy at a staff meeting
 Distribute research and reports on health literacy
to colleagues
 Propose a workgroup to explore simple changes
that can be made to promote health literacy
48
What questions do you have?
This presentation was produced by John Snow Inc., under
Contract #HHSH25020140037I with the Health Resources
and Services Administration, U.S. Department of Health and
Human Services.
49
Health literacy training materials, brochures, and
posters are available for download on the In It
Together website
https://hivhealthliteracy.careacttarget.org
50
Health insurance literacy materials are
available at the ACE TA Center
https://careacttarget.org/ace
51
Thank you!
Please complete your
evaluation.
[INSERT LINK HERE]
52